Negating the fulcrum effect in manual laparoscopic surgery: Investigating skill acquisition with a haptic simulator.

BACKGROUND: Manual laparoscopic surgery requires extensive training and familiarization. It has been suggested that motion inversion caused by the 'fulcrum effect' is key to motor challenges. We investigate the potential of a conceptual semi-robotic handheld tool that negates natural inversion.

METHODS: A custom laparoscopic simulator with haptic feedback was developed to allow interactive evaluation of the conceptual tool via virtual prototyping, prior to fabricating a physical prototype. Two groups of eight participants each used either the conceptual or a regular virtual tool over a ten week study to complete two abstract tasks of motor control and force regulation.

RESULTS: Statistically significant higher rates of skill improvement were demonstrated with the conceptual tool for motion efficiency, task completion time and error reduction. Force regulation increased for both groups but without significant differences.

CONCLUSIONS: The results indicate potential for fulcrum-negating hand tools in reducing the time needed to acquire motor skills.